...Olivia Reyna Signs of Respiratory March 10, 2013 Learning the signs of respiratory distress: Children who are having a difficult time breathing often show signs that they are not getting enough oxygen, indicating respiratory distress. Below is a list of some of the signs that may indicate that your child is not getting enough oxygen. It is important to learn the signs of respiratory distress to know how to respond appropriately. • breathing rate An increase in the number of breaths per minute may indicate that a person is having trouble breathing or not getting enough oxygen. • color changes A bluish color seen around the mouth, on the inside of the lips, or on the fingernails may occur when a person is not getting as much oxygen as needed. The color of the skin may also appear pale or gray. • grunting A grunting sound can be heard each time the person exhales. This grunting is the body's way of trying to keep air in the lungs so they will stay open. • nose flaring The openings of the nose spreading open while breathing may indicate that a person is having to work harder to breathe. • retractions The chest appears to sink in just below the neck and/or under the breastbone with each breath - one way of trying to bring more air into the lungs. • sweating There may be increased sweat on the head, but the skin does not feel warm to the touch. More often, the skin may feel cool or clammy. This may happen when the breathing rate is very fast. • wheezing A tight...
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...The logic of “Neonatal Mortality From Respiratory Distress Syndrome: Lessons for Low-Resource Countries”. 1. The main purpose of this article is to understand the interventions that have decreased the rates of RDS-specific mortality in high-income countries over the past 60 years and how to use these interventions to improve survival rates for newborns with RDS in low- resource countries. 2. The key question that the author is addressing is How the current highly successful technologies available for the treatment of RDS could be used most efficiently to save the newborn lives in low resource settings? 3. The most important information in this article is The most important information in this article is the comparison of the neonatal mortality rate related to RDS in the high resource country like United States and the low-resource country like India. The study has done in 100 premature infants born >1500 g and does not need any specialized neonatal care. With the use oxygen alone as a basic treatment for RDS, 25 of the infants could be salvaged. Of the remaining 75, CPAP plus oxygen would be sufficient to treat 45 of them. An additional 15 of them might be saved with the additional use of surfactant. 10 infants could be saved with prolonged mechanical ventilation. With all these therapies ~95% of premature neonates who are >1500 g with RDS could be saved in the United States. In contrast In India the mortality rate is still 57%- 89%...
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...neonates with respiratory distress syndrome. Respiratory distress syndrome is caused by a deficiency, dysfunction, or inactivation of pulmonary surfactant and is a significant cause of morbidity or mortality of preterm infants. The literature reviewed, highlights the differences in extracted natural surfactants and synthetic surfactants and whether one proves to be more beneficial over the other. Pfister RH, Soll R, Wiswell TE. Protein-containing synthetic surfactant versus protein-free synthetic surfactant for the prevention and treatment of respiratory distress syndrome. Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD006180. DOI: 10.1002/14651858.CD006180.pub2. In the above article the use of synthetic surfactant is discussed with regards to protein containing or non-protein containing synthetics. The synthetics that contain proteins have shown a higher efficacy in preventing respiratory distress syndrome than those without. The research suggests the reasoning for this is due to the synthetic containing proteins acting like naturally occurring surfactant proteins. This research lends to the rationale that the synthetic containing protein surfactants effectiveness being like that of a natural surfactant could be more readily available than natural surfactant. (Pfister RH, Soll R, Wiswell TE, Cochrane Database of Systematic Reviews, Issue 4) Soll R, Blanco F. Natural surfactant extract versus synthetic surfactant for neonatal respiratory distress syndrome...
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...Respiratory Failure and Acute Respiratory Distress Syndrome Acute Respiratory Distress Syndrome (Acute Lung Injury) Patient Profile Mr. J. is a 55-year-old African American man who was admitted 72 hours ago to a general surgical unit after surgery for a bowel obstruction. The surgical procedure involved extensive abdominal surgery to repair a perforated colon, irrigate the abdominal cavity, and provide hemostasis. During surgery his systolic blood pressure dropped to 70 mm Hg. Seven units of packed red blood cells and 4 L of normal saline were administered intravenously to restore blood loss and circulating volume. He is receiving 60% O2 through an aerosol face mask. He is being monitored with a cardiac monitor and pulse oximeter. He has a central intravenous catheter in place and is receiving 0.9% normal saline IV at 125 ml per hour. A urinary catheter is in place. Subjective Data • Complains of shortness of breath, inability to lie flat, and diffuse abdominal pain Objective Data Physical Assessment • General: alert, well-nourished man who appears restless and anxious; head of bed elevated 45 degrees; skin cool with moderate diaphoresis • Respiratory: no accessory muscle use, retractions, or paradoxic breathing; respiratory rate 28 breaths/min; SpO2 88%; fine crackles at lung bases. The nurse also assessed the patient’s chest and abdominal wall excursion as well as depth and pattern of respiration. • Cardiovascular: blood pressure 100/60 mm Hg; cardiac...
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...Definitions of systemic inflammatory response syndrome (SIRS), sepsis, septic shock, and multiple organ dysfunction syndrome Systemic inflammatory response syndrome Two or more of the following clinical signs of systemic response to endothelial inflammation: • Temperature > 38°C or < 36°C x Heart rate > 90 beats/min • Tachypnoea (respiratory rate > 20 breaths/min or hyperventilation (Paco2 < 4.25 kPa)) • White blood cell count > 12 ⋅ 109/l or < 4 ⋅ 109/l or the presence of more than 10% immature neutrophils In the setting (or strong suspicion) of a known cause of endothelial inflammation such as: • Infection (bacteria, viruses, fungi, parasites, yeasts, or other organisms) • Pancreatitis x Ischaemia x Multiple trauma and tissue injury x Haemorrhagic shock x Immune mediated organ injury x Absence of any other known cause for such clinical abnormalities Sepsis Systemic response to infection manifested by two or more of the following: • Temperature > 38°C or < 36°C x Raised heart rate > 90/min • Tachypnoea (respiratory rate > 20 breaths/min or hyperventilation (Paco2 < 4.25 kPa)) • White blood cell count > 12 × 109/l or < 4 × 109/l or the presence of more than 10% immature neutrophils Septic shock Sepsis induced hypotension (systolic blood pressure < 90 mm Hg or a reduction of >40 mm Hg from baseline) despite adequate fluid resuscitation Multiple organ dysfunction syndrome Presence of altered organ...
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...carrier; Divorced: has two adult children who live out of town, but visit frequently. Latest Assessment: Vital Signs: HR 82, BP 124/75, RR 14, SPO2 98% on 36% tracheostomy collar, T 99 Cardiovacular: Normal sinus rhythm Respiratory: Breath sounds with ronchi bilaterally; equal expansion, trach tube intact, and insertion site clean and dry. GI: normal bowel sounds, PEG tube intact dressing dry GU: WNL Extremities: equal bilaterally, strong peripheral pulses Neurological: Alert and oriented to time, place and person, pupils equal and reactive to light and accommodation Pain: no complaints of pain Learning objectives * Perform assessment on the patient * Demonstrates appropriate tracheal suctioning techniques, including ongoing assessment of respiratory status * Intervenes appropriately to resolve acute respiratory distress in patient with tracheostomy Preparation questions: 1. What are some of the indications for a tracheostomy? * Prolonged intubation during the course of a critical illness * Severe neck or mouth injuries * Long term unconsciousness or coma, * To maintain an airway where the ability to do this via normal mechanisms is temporarily or permanently compromised * To facilitate longer-term respiratory support such as mechanical ventilation or...
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...Problem:Chest pain, back painPriority Assessments:Vital signs, telemetry, peripheral pulses, respiratory status, monitor for signs and symptoms of bleeding, pain assessment, restlessness, irritability, confusion, somnolence, tachypnea, dyspnea, significant decrease in oximetry results, decreased PaO2 and/or increased PaCO2, central cyanosis | #3 Nursing Diagnosis:Impaired physical mobility Supportive Data:R/T left lower extremity clot and right lower extremity edema and pain AEB c/o pain with ambulation and ROM of lower extremities | Relationship of Diagnoses BRIEFLY explain the relationship (causative or resultant) between your selected nursing diagnoses. If the diagnoses are unrelated, state that. The impaired gas exchange and impaired physical mobility are directly related to the patient’s diagnosis of DVT and PE. The risk for bleeding is correlated because of the heparin drip needed for the treatment of PE and DVT. | Priority Nursing Diagnosis: Goal, Outcomes, Interventions and Responses Priority Nursing Diagnosis Impaired gas exchange r/t decreased pulmonary perfusion aeb c/o SOB with any exertion, pain with deep breathing, and decreased O2 saturation with ambulation. Expected Outcomes (measurable) INTERVENTIONS | CLIENT RESPONSE TO INTERVENTIONS | INSTRUCTOR FEEDBACK | 1.) Maintain client on bed rest to reduce oxygen demands during acute respiratory distress; increase activity gradually as allowed and tolerated2.) Maintain oxygen therapy as ordered3...
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... B, a 67-year-old patient, arrives at the six-room emergency department (ED) of a sixty-bed rural hospital. He has been brought to the hospital by his son and neighbor. At this time, Mr. B is moaning and complaining of severe pain to his (L) leg and hip area. He states he lost his balance and fell after tripping over his dog. Mr. B was admitted to the triage room where his vital signs were B/P 120/80, HR-88 (regular), T-98.6, R-32, and his weight was recorded at 175 pounds. Mr. B. states that he has no known allergies and no previous falls. He states, “My hip area and leg hurt really bad. I have never had anything like this before.” Patient rates pain at ten out of ten on the numerical verbal pain scale. He appears to be in moderate distress. His (L) leg appears shortened with swelling (edema in the calf), ecchymosis, and limited range of motion (ROM). Mr. B’s leg is stabilized and then he is further evaluated and discharged from triage to the emergency department (ED) patient room. He is admitted by Nurse J. The admitting nurse finds that Mr. B has a history of impaired glucose tolerance and prostate cancer. At Mr. B’s last visit with his primary care physician, laboratory data revealed elevated cholesterol and lipids. Mr. B’s current medications are atorvastatin and oxycodone for chronic...
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...Richard J. Meadows Bellevue University MBA 626, T303, Operations Management Field Exercise 20 May 2012 Overview Kinetic Concepts, Incorporated (KCI) headquarters is located in San Antonio, Texas. They have been in business since 1976 and have operations in the United States, Austria, Germany, United Kingdom, Denmark, France, the Netherlands, Switzerland, Sweden, Italy and Canada with a total of 2,106 employees world wide. Kinetic Concepts developed therapeutic healing systems that address conditions such as skin breakdowns, circulatory problems and pulmonary complications with immobility. They are the international leader in providing specialized hospital equipment to speed recovery in immobilized patients. KCI has state of the art products ranging from surfaces that help burned skin heal, machines that speed wound recovery and mattresses that turn patients automatically. They have worked on well known patients like Christopher Reeves and Boris Yeltsin. Interview Date and Location The interview and visit was conducted on Friday, 20 April 2012, 0900 – 1500 hours with Mr. Adams, District Sales and Government Contracts Manager located in Seattle, Washington. During my visit Mr. Adams introduced me to his staff, gave me a tour of their facility, set up and performed operations from the call center to the maintenance and cleaning of their products when returned to the company. I was even treated...
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...Acute Biologic Crisis General Description: This concept in N-302 deal with clients in acute Biologic Crisis. The nurse, utilizing the nursing process, focuses in assisting and giving immediate care and attention to the client to restore life processes to a state of dynamic equilibrium. • Attend to specific needs of patient under ABC • Identify types of data needed for care • Prioritize NCP • Alleviate physiologic stressors specific to patient • Describe and appreciate the role of a critical care nurse The Topics A. Concept of Critical Care Nursing B. Application C. Definition Pre-term Post-term Acute MI Thyroid Storms and Crisis Hepatic Coma ARDS Diabetic Ketoacidosis CVD End Stage Renal Stage The Concept of Critical Care Nursing Delivery of specialized care to critically-ill patients with life-threatening such as major surgery, trauma, infection, and shock as well as prevention of potential life-threatening conditions. The critical care nurse is responsible for ensuring that all critically-ill patients and families receive optimal care. Common Illnesses and Injuries seen in ICU: 1. GSW (Gunshot Wounds) 2. Traumatic Injuries (car collision & falls) 3. CV D/O (heart failure, acute coronary syndrome, unstable angina, MI) 4. Surgeries (abdominal aortic aneurysm repair and endarterectomy) 5. Renal D/O (acute and chronic renal failure) 6. GI and Hepatic D/O (acute pancreatitis, acute UGIB or Upper Gastro Intestinal Bleeding, acute...
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...non-favorable effects such as increased anxiety levels which can subsequently lead to somatic reactions such as tachycardia, dyspnea, increased blood pressure and patient-ventilator dyssynchrony. Prolonged anxiety levels can also induce psychological effects such as increased fear and inhibitions. This can ultimately affect the patient’s overall capacity to cope with difficult emotions and situations (Richart-Martinez & Perpina-Galvan, 2009). These effects can lead to the need for more sedation which can hinder weaning attempts. The longer a patient is mechanically ventilated the greater the risk of developing Ventilator Associated Pneumonia, (VAP), and Adult Respiratory Distress Syndrome (ARDS). VAP is a pneumonia that develops 48 hours or longer after mechanical ventilation. It results from the invasion of the lower respiratory tract and lung parenchyma by microorganisms. Intubation compromises the integrity of the oropharynx and trachea and allows oral and gastric secretions to enter the lower airways. ARDS is a life-threatening lung condition that prevents enough oxygen from getting into the blood. The purpose of this study is to evaluate the effectiveness of stress reducing, non-pharmacologic interventions on mechanically ventilated patients when used in conjunction with pharmacologic interventions to decrease overall anxiety. Research efforts of...
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... B, a 67-year-old patient, arrives at the six-room emergency department (ED) of a sixty-bed rural hospital. He has been brought to the hospital by his son and neighbor. At this time, Mr. B is moaning and complaining of severe pain to his (L) leg and hip area. He states he lost his balance and fell after tripping over his dog. Mr. B was admitted to the triage room where his vital signs were B/P 120/80, HR-88 (regular), T-98.6, R-32, and his weight was recorded at 175 pounds. Mr. B. states that he has no known allergies and no previous falls. He states, “My hip area and leg hurt really bad. I have never had anything like this before.” Patient rates pain at ten out of ten on the numerical verbal pain scale. He appears to be in moderate distress. His (L) leg appears shortened with swelling (edema in the calf), ecchymosis, and limited range of motion (ROM). Mr. B’s leg is stabilized and then he is further evaluated and discharged from triage to the emergency department (ED) patient room. He is admitted by Nurse J. The admitting nurse finds that Mr. B has a history of impaired glucose tolerance and prostate cancer. At Mr. B’s last visit with his primary care physician, laboratory data revealed elevated cholesterol and lipids. Mr. B’s current medications are atorvastatin and oxycodone for chronic...
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...of acute abnormalities. The chest x –ray re-demonstrated the pan coast tumor with possible underlying infection. Sinuitis also was noted on the CAT scan. The patient was admitted to the floor because of her shortness of breath and level of confusion. Antibiotics were administrated for the pneumonic process and Neupogen was given. The patient was put on oxygen therapy and aerosol treatments and later was transferred to the ICU because of respiratory failure. The patient was placed on a mechanical ventilator when sent to ICU with the new status of DNRCC-A and was extubated on 3/6/10 and died. Past Medical History The patient has a history of depression and acute mental status change. The patient has a surgical history of an A-port insertion. History of Present Illness The patient came into the emergency room complaining of confusion and weakness after her fifth cycle of chemotherapy was done earlier that day. Physical Exam on Admission Vital Signs | Actual Values | Reference Values | Temperature | 98.7F | 97.0- 99.5F | Respiratory Rate | 20 bpm | 12- 20 bpm | Pulse | 121 bpm | 60- 100 bpm | Blood Pressure | 151/79 mm Hg | 60-90/90-140 mm Hg | Weight | 85 lbs | 115 lbs | HEENT: No abnormalities Neck: No abnormalities; no masses present Pulmonary: Shallow respirations with decreased breath sounds bilaterally with...
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...marijuana is illegal, yet alcohol and tobacco are available and regulated? There are many people that support the claim that marijuana is unhealthy and dangerous. There are many who think we need to keep drugs illegal to protect our society from the addictions and diseases that they cause, however this is impossible because we have alcohol and tobacco that is sold in every store. Therefore, these arguments are not consistent with the fact that the two most deadly drugs in U.S. are legal. Alcohol and tobacco have been labeled as more addictive and harmful than marijuana, yet readily available. According to researched done by the Journal of the American Medical Association (JAMA, 1996), alcohol abuse increases the risk of developing acute respiratory distress syndrome (ARDS). The National Institute of Health also suggests that there may be a connection between alcohol consumption and increased risk for cancer (NIH, 2012). Similarly, the Center for Disease Control (2012) reports that nicotine, the active chemical in tobacco, is...
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...ARDSnet OXYGENATION GOAL: PaO2 55-80 mmHg or SpO2 88-95% Use a minimum PEEP of 5 cm H2O. Consider use of incremental FiO2/PEEP combinations such as shown below (not required) to achieve goal. Lower PEEP/higher FiO2 FiO2 0.3 0.4 0.4 PEEP 5 5 8 0.5 8 0.9 16 0.5 10 0.9 18 0.6 10 1.0 18-24 0.7 10 0.7 12 NIH NHLBI ARDS Clinical Network Mechanical Ventilation Protocol Summary FiO2 PEEP 0.7 14 0.8 14 0.9 14 INCLUSION CRITERIA: Acute onset of 1. PaO2/FiO2 ≤ 300 (corrected for altitude) 2. Bilateral (patchy, diffuse, or homogeneous) infiltrates consistent with pulmonary edema 3. No clinical evidence of left atrial hypertension PART I: VENTILATOR SETUP AND ADJUSTMENT 1. Calculate predicted body weight (PBW) Males = 50 + 2.3 [height (inches) - 60] Females = 45.5 + 2.3 [height (inches) -60] 2. Select any ventilator mode 3. Set ventilator settings to achieve initial VT = 8 ml/kg PBW 4. Reduce VT by 1 ml/kg at intervals ≤ 2 hours until VT = 6ml/kg PBW. 5. Set initial rate to approximate baseline minute ventilation (not > 35 bpm). 6. Adjust VT and RR to achieve pH and plateau pressure goals below. Higher PEEP/lower FiO2 FiO2 0.3 0.3 0.3 PEEP 5 8 10 FiO2 PEEP 0.5 18 0.5-0.8 20 0.3 12 0.8 22 0.3 14 0.9 22 0.4 14 1.0 22 0.4 16 1.0 24 0.5 16 __________________________________________________________ PLATEAU PRESSURE GOAL: ≤ 30 cm H2O Check Pplat (0.5 second inspiratory pause), at least q 4h and after each change in PEEP or VT. If Pplat > 30 cm H2O: decrease...
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